By now the lines have been drawn around the wisdom of
President Obama’s challenge to cure cancer in America with yet another moon
shot.

There
are many who welcome the government’s declaration of episode 16 of Star Wars on
Cancer with Vice President Biden playing the role of Andy von Eschenbach or is
that Luke Skywalker, while President Barry plays Tricky Dicky (Darth Vader?).
Don’t put me in this camp.

There
are others who are cynical about yet another pledge to cure cancer by an
elected or appointed official. Don’t put me in this camp either, even though I
believe these sorts of programs are bad ideas and the pledges even worse. The
goal of curing cancer is no more like going to the moon than it is like preventing
infections with a new virus. We know how to make vaccines against viruses. We
do not yet hold the key to curing malignant disease. Even when we can cure
cancer, we don’t really know how the magic worked. Serendipity and empiricism
still rule cancer treatment progress via clinical research.

1. Is the
science establishment calling for his head (meaning Biden’s)? Not really. Most smell more money.

2. Is there a
real deadline? For what? If it
is to cure cancer, I haven’t heard it and that would require a definition of
“cure cancer.”

3. Is Biden’s
moonshot at least doing the easy things? You define the easy things, then I will tell you
whether or not they are being done. But first, we need to determine if the
“easy things” are even smart ideas like sequencing the world’s tumor DNA.

4. Is it not
duplicating what’s already being done? I cannot imagine anything not being done unless it hasn’t been thought
of, people are too obstinate to cooperate, or there isn’t enough money to do it.

5. Does the
program emulate venture capitalists? If that means high risk, we’re there, given the amount spent so far
and the relative progress that has been made. Good progress to date. Very
costly.

7. Does it
involve scientists outside cancer biology? To some extent, but it could be better as the key to
cancer could as easily reside in a physics lab as a molecular biology one.

These
are all reasonable questions, but what I saw in the days since the State of the
Union message was back peddling. Where that evening we were going to cure
cancer in America, now the goals of the Biden effort are to increase funding
and increase collaboration to get done in 5 years what would have been done in 10
at today’s pace.

(SeeCancer Letter of January 22)

How
many times have we heard that malarkey?

The
real problem with all this moon shot talk is that it tries to place the
scientific into the realm of the engineering and the political. This is a bad
idea.

If
we ever can eradicate cancer as a scourge on mankind it will take the
following:

1. Defining cancer better. And that includes its true
cause which may or may not be gene mutations which could be effects not causes.

2. Developing something like Koch’s Postulates for cancer
even if it proves to not be an infectious disease in all its forms. (That means
a cancer gene would have to transform a well animal to a sick one with a
disease identical to one in the sick one and then have this model hold up in
people. This will always be a problem in people as discerning the causative
event in any individual’s established cancer is probably impossible most of the
time because we haven’t worked out that time travel backwards thing yet so we
can see in an unambiguous fashion HOW a cancer patient got the cancer).

3. Define cure. (Probably a patient dies of something
else. This has been done with Hodgkin’s Disease, some lymphomas, testicular
cancer, childhood leukemia, choriocarcinoma in women, Wilm’s tumor and others.
Unfortunately, the something else is not infrequently a long-term effect of
cancer treatment so we still have a way to go there as well.) By the way, I am
not sure we are certain of the mechanisms by which we cure these cancers with
the exception of chronic myeloid leukemia.

4. Finding cancers true origins and preventing cancer
especially those forms linked more to life style choices than to genetic
proclivities. (The latter can be done now with efforts against smoking, hepatitis, HIV, HPV, colon
polyps, etc as well as possibly with genetic screening. Imagine if all that new
money was used to make sure that everyone in America who needed a colonoscopy
got one? You want to end colon cancer deaths? We can. Right now. No research
needed).

If
the Vice President really wants to do that he has to get the money to
incentivize the collaboration as a start. It will also necessitate eliminating
the current system of rewards in academia that are totally based on individual
effort (e.g., tenure). The intellectual property laws will have to change so
that finding the cure will reward all of mankind not just the company that
makes the drug. The regulatory environment must change to ease access to
clinical trials, experimental drugs, and data sharing. Electronic medical
records must talk to one another if the data are to be shared and privacy laws
must incentivize data sharing.

So
there are a lot of things that Mr. Biden can do at the federal level to hasten
the day that cancer is eradicated. Pouring more money into the NIH and
expecting people to collaborate when they are rewarded as individuals makes no
sense to me.

I
wish the Vice President well as I know how passionate he is about this issue.
Losing a child to cancer is devastating. Losing a parent is as well, but that
has not made Dr. DePinho a reasonable steward of the resource that is MD
Anderson. These political folks simply do not understand the problem like a
real cancer biologist or oncology physician does. Ask those people what they need
and then align their needs with your political goals. When that happens and all
the rest of the stuff above happens, then maybe progress will ensue at a greater
rate than currently. If not, we will keep poking along as humans tend to do, making
progress with empiricism and serendipity as frequently as we do with planning.